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Gresch M, von Dercks N, Dietze-Jergus N, Roth A, Pempe C. Infectiological Outcome of Total Hip and Total Knee Arthroplasty in Post-Traumatic and Primary Osteoarthritis. Antibiotics (Basel) 2024; 13:1186. [PMID: 39766576 PMCID: PMC11672522 DOI: 10.3390/antibiotics13121186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/18/2024] [Accepted: 12/04/2024] [Indexed: 01/11/2025] Open
Abstract
Background: The objective of this study was to compare infection rates, pathogen species detection and antimicrobial susceptibility testing in patients with total hip arthroplasty (THA) and total knee arthroplasty (TKA) following post-traumatic osteoarthritis (PTOA) and primary osteoarthritis (POA). Results: Patients undergoing both THA and TKA were significantly more likely to have a PJI after PTOA than after POA (THA: 2.5% vs. 10.2%, p = 0.003; TKA: 3.2% vs. 10.3%, p = 0.028). The most frequently detected pathogen in both THA and TKA was Staphylococcus spp. Among patients with a PJI in THA, Staphylococcus spp. was detected in 47% after POA and 60% after PTOA. Among patients with a PJI in TKA, Staphylococcus spp. was isolated in 59% after POA and 80% after PTOA. The remaining pathogens were mainly Enterococcus spp., Enterobacterales and anaerobic bacteria. After THA, beta-lactam-resistant staphylococcal isolates were detected more frequently in PTOA patients than in POA patients (13% vs. 100%, p = 0.024). There was no difference in the beta-lactam staphylococcal resistance rate in patients after TKA (20% vs. 25%, p = 0.945). Furthermore, an analysis of susceptibility testing from all groups showed that significantly more pathogens were susceptible to vancomycin than to cefuroxime (76% vs. 45%, p < 0.001) or clindamycin (76% vs. 52%, p = 0.007). Methods: A retrospective analysis was performed using clinic-owned data during the period January 2016-December 2020. A total of 1485 patients following primary implantation of THA or TKA due to PTOA or POA were included. Early-onset periprosthetic joint infection (PJI), defined according to the 2018 Definition of Periprosthetic Hip and Knee Infection Criteria, was evaluated. Conclusions: Therefore, the use of vancomycin as a perioperative prophylaxis should be discussed under benefit/risk consideration in further studies.
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Affiliation(s)
- Maximilian Gresch
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04317 Leipzig, Germany; (A.R.)
| | - Nikolaus von Dercks
- Department of Medical Management, University Hospital Leipzig, 04317 Leipzig, Germany
| | - Nadine Dietze-Jergus
- Institute of Medical Microbiology and Virology, Department of Microbiology, University Hospital Leipzig, 04317 Leipzig, Germany
| | - Andreas Roth
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04317 Leipzig, Germany; (A.R.)
| | - Christina Pempe
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04317 Leipzig, Germany; (A.R.)
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Fenske F, Kujat B, Krause L, Meyer S, Sander AK, Repmann J, Neuhaus M, Haak R, Roth A, Lethaus B, Ziebolz D, Schmalz G. Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study. Infection 2024; 52:535-543. [PMID: 38060067 PMCID: PMC10954939 DOI: 10.1007/s15010-023-02128-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE The oral cavity and, in particular, potential oral foci might pose a risk of periprosthetic joint infection (PJI). The aim of this cohort study was to determine whether practical preoperative dental screening would reduce the prevalence of early PJI in the first month after surgery. METHODS Patients attending a specialized endoprosthesis implantation clinic between 2018 and 2022 were recruited. Two groups were examined. The test group consisted of patients attending the clinic between 2020 and 2022 and who were referred to their family dentist using a standardized form. The comparison group consisted of patients who were treated in the clinic between 2018 and 2020. They were not referred to their family dentist. The two groups were compared for the prevalence of PJI. Univariate analysis followed by multiple logistic regression was performed to confirm risk factors for PJI in this cohort. RESULTS 2560 individuals (test group: 1227, comparison group: 1333) were included. The prevalence of PJI was significantly lower in the test group (0.8% vs. 1.8%, p = 0.04). Multiple logistic regression with PJI as the dependent variable showed that a dental referral was a strong predictor of a lower prevalence of PJI (OR: 0.43, CI95 0.205-0.917, p = 0.03). Male gender was also strongly associated with a higher frequency of PJI (OR: 2.68, CI95 1.32-5.42, p = 0.01). Age (OR: 1.06, CI95 1.01-1.10, p = 0.01) and BMI (OR: 1.11, CI95 1.05-1.17, p < 0.01) had little effect on the risk of PJI. CONCLUSION Dental referral using a standardized form can reduce the prevalence of early PJI. Accordingly, orthopedists and dentists should collaborate in this practical way.
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Affiliation(s)
- Fabian Fenske
- Department of Oral and Maxillofacial Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
| | - Benjamin Kujat
- Specialized Clinic for Orthopedics, Mediclin Waldkrankenhaus Bad Düben, 04848, Bad Düben, Germany
| | - Leah Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103, Leipzig, Germany
| | - Stephan Meyer
- Department of Oral and Maxillofacial Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Anna-Katharina Sander
- Department of Oral and Maxillofacial Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Jaqueline Repmann
- Specialized Clinic for Orthopedics, Mediclin Waldkrankenhaus Bad Düben, 04848, Bad Düben, Germany
| | - Michael Neuhaus
- Department of Oral and Maxillofacial Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103, Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103, Leipzig, Germany
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Mestres C, Van Hemelrijck M, Quintana E, Smit FE. Significance and current approaches to vascular graft infection. Indian J Thorac Cardiovasc Surg 2023; 39:333-340. [PMID: 38093914 PMCID: PMC10713901 DOI: 10.1007/s12055-023-01638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023] Open
Abstract
Vascular graft/endograft infection (VGEI) is a constant in cardiovascular surgery with published rates between 1 and 5%. Every graft type and anatomical location is a potential target for infectious complications. These patients are sick patients with high frailty burden. Management of VGEI entails a multidisciplinary and multimodality approach. Here we review some aspects of the problem of VGEI including prevention, diagnosis, and surgical therapy with focus on recent developments in the field.
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Affiliation(s)
- Carlos–Alberto Mestres
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
| | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
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